National Alliance on Mental Illness
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Treatment & Other Approaches
Developmental Approaches focus on the process of acquiring skills in stages from simple to complex. The most well-known of these interventions is Dr. Stanley Greenspan’s Developmental, Individual-Difference, Relationship Based (DIR) model, which focuses on “floortime.” “Floortime” allows the adult to follow the child’s lead to engage in play, and that, in turn, may provide opportunities for connection and perhaps more complex emotional and social relating. At the present time, there is little evidence to prove the effectiveness of this approach.
Presently, it is believed that the earlier intensive interventions begin, the better the outcome, despite many unknowns. Factors that may influence the outcomes of early intervention programs are varied beyond the specific nature of any one approach.
Inclusion in the Classroom
Once educated in alternative settings, educators and parents can concentrate on finding the most effective way to teach these students. The classroom setting is still not at the level of individualized treatment that students with Autism Spectrum Disorders (ASDs) need in order to achieve success. Many are lost in the shuffle of special education, or in a regular education setting that focuses on traditional learning methods. As the number of students with ASDs attending public schools grows, school systems and teachers will need to become better equipped with targeted educational tools to provide the environment needed.
Students with ASDs are often recognized by their ineptness in social interactions with others, and often say things that are inappropriate or rarely speak, if at all. If the student remains in a special education setting with fewer interactions with mainstream classmates, research shows that little or no social growth will occur. Therefore, it is important to teach individuals with an ASD how to form relationships and understand the feelings of others. It is the school’s responsibility to work this into the curriculum, whether in a mainstream or special education classroom. The success of the inclusion depends on the severity of the child with the disorder, the attitude and training of the educator, and the collaboration of those involved.
Doctors may prescribe a variety of drugs to reduce self-injurious behavior or other troublesome symptoms of ASDs, as well as associated conditions such as epilepsy and attention disorders. Most of these drugs affect levels of serotonin or other signaling chemicals in the brain. The medications most often used in the treatment of ASDs can generally be placed in one of the following groups: antipsychotic drugs, antidepressants, and stimulants.
Antipsychotic drugs: Some of the newer antipsychotics are used to treat irritability and behavioral problems, such as aggression, self-injury, and rapid mood swings. Atypical antipsychotics have few unwanted side effects compared to typical antipsychotics and are used in the treatment of ASDs.. Risperidone (Risperdal) is the most frequently prescribed and FDA approved for treatment of some ASDs-related symptoms in children and adolescents.
Antidepressants: Primarily used to treat depressive disorders, they are also effective for the treatment of anxiety disorders including obsessive compulsive disorder. There are four main categories of antidepressants: monoamine oxidase (MAO) inhibitors, tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and “other agents.” TCAs and SSRIs are the most studied in autism. The results have not been clearly beneficial, but despite this fact, many antidepressants are being used in the treatment of children. The symptoms targeted by these drugs include aggression, self-injurious behavior, anxiety, agitation, and over-activity.
Stimulants: Primarily used to tread attention deficit hyperactivity disorder (ADHD), many children with ASDs exhibit similar symptoms of inattention, over-activity, and impulsivity, and the use of these stimulant medications are commonly used. Methylphenidate (Ritalin) is the most studied and commonly used psychostimulant. About half (49 percent) of children with autism responded to methylphenidate with decreased hyperactivity and inattention. A large percentage of those treated (18 percent) experienced significant side effects. Side effects vary from user to user.
The treatment for ASDs currently focuses on the brain. Other body systems are also coming into focus for drug therapy: the gastrointestinal tract and the immune system of children with ASD are of interest.
Vitamin Supplements & Essential Fatty Acids
Vitamins and other nutritional supplements are substances that are either essential for normal body functions or are thought to enhance the body’s functioning. Vitamins and minerals are required in small amounts by all humans for normal growth and development. Essential fatty acids and amino acids are also required by the body and obtained from certain foods Many of these products are not being studied with the same rigor and scrutiny which has traditionally been applied to drugs and medications used to cure, treat, and/or prevent illness. Several reasons to suspect that children with ASDs may not be getting sufficient nutrients include chronic diarrhea or constipation, gastrointestinal inflammation, and a tendency to restrict food choices. It is possible that children with ASDs do not break down or process the nutrients they do consume in expected ways.
Mega-vitamin therapy and other nutritional supplements are commonly used to treat ASDs. Essential fatty acids make up about 20 percent of the dry-weight of the brain and are believed to be crucial to the brain’s optimal functioning. The two key essential fatty acids are Omega-3 and Omega-6. They can impact both the thought processes and behavior. Deficiencies in Omega-3 fatty acids may be linked to ASDs as well as schizophrenia, aggression, and impulsivity. Scientists now theorize that there may be some fundamental link between the lack of essential fatty acids and a variety of neuropsychiatric conditions.
Children with ASD have also been found to suffer from a severe lack of Vitamin C. This is imperative, as studies have shown Vitamin C to influence the functioning of the human body and brain.
With the emergence of new support groups and studies centering on the causes of ASDs, more research is anticipated to follow. Parents should be prepared when embarking on new treatment options. To get tips on how to evaluate your loved one’s plan of care, see “Parental Support.”
Child Psychiatry and Autism: http://www.iancommunity.org/cs/therapies_treatments/child_psychiatry_and_autism
“Can antipsychotic medication help my child?”: http://www.iancommunity.org/cs/therapies_treatments/antipsychotics_malone
Expert interview with Laura Schreibman, Ph.D., on ASD and Applied Behavior Analysis: http://www.medscape.com/viewarticle/554574
Interactive Autism Network Treatment Reports: Medications: http://www.iancommunity.org/cs/ian_treatment_reports/medication